Dr. Roach: How to keep‘smoldering’ myeloma at slow pace
Dear Dr. Roach: More than a year ago, I was diagnosed with multiple myeloma in the smoldering stage, based on a bone marrow biopsy and blood tests. Every three months, my hematologist checks my blood tests and tells me that when I feel bone pain, it will be time to begin chemo. While I am in the smoldering stage, is there anything I can do to prolong the shift to the full-blown stage? I am 79 and otherwise in good health. My only symptoms are some fatigue and lack of energy.
Dear W.K.: Multiple myeloma is a type of cancer of blood cells — the plasma cells, which are responsible for making antibodies. Most, if not all, cases of myeloma have a precursor stage called MGUS, monoclonal gammopathy of uncertain significance. About 3 percent of all people older than 50 have MGUS, and about 1 percent of people with MGUS will develop MM per year. “Smoldering” MM is the diagnosis when the bone marrow biopsy shows evidence of MM but there are no other signs of MM. Signs of MM include myeloma in the bones (on X-ray or CT, called lytic lesions, since they “lyse,” or cause holes in, the bones), anemia, high calcium, poor kidney function and high viscosity of the blood, which predisposes a person to strokes.
In addition to looking for physical symptoms, your hematologist is searching for any of these findings. In addition, the amount of immunoglobulin in the blood predicts risk for developing overt MM (the higher the immunoglobulin, the higher the risk). A level over 1.5 g/dL puts you at high risk. Although trials are ongoing, there are no generally accepted treatments to prevent progression to MM for people with MGUS or smoldering myeloma.
Dear Dr. Roach: I am 84. I have been diagnosed with a bursa behind my left knee. It has grown to the size of a lemon and causes me quite a bit of discomfort. It affects the way I walk and stand. I have been to two orthopedic doctors, and they are reluctant to drain it but won’t explain why. I am otherwise in excellent physical condition.
Dear J.W.: It sounds like you are talking about a popliteal or Baker’s cyst. X-ray and ultrasound can confirm this. At your age, it is likely related to osteoarthritis of the knee. Most surgeons do treat these with a combination of drainage and (at the same time) injection of the knee with a corticosteroid such as cortisone.
Since they seem reluctant to do this, it may be that I am guessing wrong at your diagnosis, so when you see the doctor, ask the diagnosis and write me back.
Email questions to ToYourGoodHealth@med.cornell.edu.